ボツリヌス治療

抄録

Botulinum toxin has been widely applied to therapeutic and cosmetic uses since 1980's. In Japan two formulations, one type A and one type B, are available under strict official regulations. Off–label use is prohibited, and the reimbursement of national insurance is too much restrictive to encourage clinicians of the next generation to launch the practice of this highly effective treatment. Moreover, many of the doctors in Japan are too busy to learn and perform this relatively time–consuming but financially unrewarded procedure. These hardships may regrettably result in the future decline, both quantitative and qualitative, of practice in the clinical setting, as far as Japan is concerned.

For injection, the author prefers 27–30 gauge thin needles to thicker ones, to minimize patient's agony, and whenever possible tries to accurately identify target muscles under the monitoring with electromyography, electrical stimulation, or ultrasonography, for the treatment of the limb or deep cervical muscles. Especially for the obliquus capitis inferior and semispinalis cervicis muscles, the ultrasound is superior to other monitoring techniques.

In spasticity many patients have anticoagulant or antiplatelet drugs for the secondary prevention of cardio– or cerebro–vascular diseases, and special care should be taken to avoid massive intramuscular bleeding in these patients. The consensus about the adequate use of these drugs still remains to be confirmed.

Antitoxin antibody may abolish the toxin effect, but significant number of patients may show apparent secondary resistance to the therapy due to another reasons than neutralizing antibody. Target sites, dose, and technical issues should be re–assessed before abandoning treatment whenever the toxin effect appears to have diminished.